Health Funds – Anticipated Requirements for Pilates Provider Eligibility

Meetings are continuing between the PAA and the health funds and their associations. Whilst the situation is still fluid and nothing has been concretely confirmed, our expectations are as follows:

 

Pilates will be recommended as eligible for the following two scenarios:

1. 1. General Treatment – In the context of health insurance, this refers to health services that manage or prevent illness, injury, or conditions and are not covered by Medicare or provided in a hospital. Examples include dental care, physiotherapy, podiatry, chiropractic services, and optical services, and it is often covered through specific private health insurance policies.
   2. Healthy Lifestyle program – This is an Extras benefit that can help to cover the cost of health management programs for specific conditions. Benefits still need to be for a health condition and may require a referral from a GP or allied health provider. For example, eligible health fund members could claim for weight management programs (e.g. Weight Watchers, CSIRO Total Wellbeing Diet) Gym membership, or other approved training programs.

The annual limits available per person per year are higher for General Treatment than for Healthy Lifestyle programs. The table below shows current examples of annual limits offered by major health insurers.

 

For General Treatment, item codes for Pilates will be created.

We anticipate item codes for:

• • Initial consultation
  • Subsequent Pilates private
  • Small group classes

Whilst a framework of codes will be set up, it will be up to the individual private health insurers as to what they cover.

 

Providers will be required to be a member of a relevant Association

It will be a requirement for Providers to be a member of the relevant Association to be eligible for General Treatment. Funds may also require Association membership for Healthy Lifestyle programs.

 

There will be further requirements around Continuing Education

One condition for members of an association that has been discussed is, “What happens if your membership has lapsed since you gained your qualification?”

It is likely that, if you have not been an Association member in the two years prior to your application or renewal, you will be required to provide evidence of Continuing Education before your membership can be approved or reinstated. This requirement is not uncommon for other associations in the natural therapies arena.

So, that would mean, for PAA membership, you would need to demonstrate 20 points.

To prepare for this potential scenario, you could attend the three-day PAA Conference in September, which will accrue 18 points. Throw in a couple of master classes and you will have easily met the requirement.

 

I wish that we could be more definitive on the details, but at this stage, there is still quite a bit of to and fro on requirements.

In the meantime, now could be the very best time to join the PAA or reinstate your membership and get your PDP’s sorted.

I will continue to provide information as the situation evolves.

 

Robyn Rix, PAA President

19/8/2025

 

Comparison of limits for General Treatment and Healthy Lifestyle cover (current as of 19.08.2025)

Insurer	Plan	General Treatment		Healthy lifestyle	Link
		Physiotherapy limit	Massage limit	Gym membership limit
Bupa	Top Extras 75	$800	$500 (combined with other “natural therapies” e.g., acupuncture, Chinese medicine)	$150	https://www.bupa.com.au/health-insurance/cover/extras/compare
Medibank	My Choice Extras Support 75	$600 (combined with chiro., acupuncture, Chinese medicine, exercise phys., and osteopathy.)	$200	$200 (gym sub-limit $125)	https://www.medibank.com.au/health-insurance/extras-cover/
HCF	Top Extras	Year 1 $600 → Year 2 $750 → Year 3+ $900	Year 1 $300 → Year 2 $400 → Year 3+ $500(combined with other “natural therapies” e.g., acupuncture, Chinese medicine)($300 sub-limit)	Up to $200	https://www.hcf.com.au/insurance/extras
HBF	Everyday Extras Mid	$450	$350 (combined with other “natural therapies” e.g., acupuncture, Chinese medicine)	$250	https://www.hbf.com.au/health-insurance/extras
nib	Core & Wellbeing Extras	$350	$300 (combined with other “natural therapies” e.g., acupuncture, Chinese medicine)	$150	https://www.nib.com.au/health-cover/extras-insurance